2 sexual transmitted infections Presentation.ppt
dcm202401577
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May 13, 2025
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About This Presentation
Sure! Here's a detailed 3000-word presentation description on Sexually Transmitted Infections (STIs) along with 30 keyword tags at the end. This could serve as a full overview, suitable for inclusion in health awareness programs, academic resources, or presentation materials.
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Comprehensiv...
Slide Content
1
SEXUALLY TRANSMITTED ILLNESSES
ken golosi
SEXUALLY TRANSMITTED ILLNESSES
ken golosi
2
Preface and introduction to the
course
State the common occurring STIs in Malawi.
Describe current methods of safer sex that you
have heard about in Malawi.
State in broad terms the significance of STIs in
Malawi.
Preface and introduction to the
course
State the common occurring STIs in Malawi.
Describe current methods of safer sex that you
have heard about in Malawi.
State in broad terms the significance of STIs in
Malawi.
3
Obj………………………….
Describe the three modes transmission of
STIs
Describe the links between HIV and other
STI.
Obj………………………….
Describe the three modes transmission of
STIs
Describe the links between HIV and other
STI.
4
Preface
Malawi government adopted the Syndromic
approach management of STIs in 1992.
The MOH was assisted by JSI-STAFH project in
the implementation in 5 pilot sites.
Based on JSI-STAFH evaluation 1997, trainers
and service provider’s were revised and the
training was extended to two weeks
Preface
Malawi government adopted the Syndromic
approach management of STIs in 1992.
The MOH was assisted by JSI-STAFH project in
the implementation in 5 pilot sites.
Based on JSI-STAFH evaluation 1997, trainers
and service provider’s were revised and the
training was extended to two weeks
5
Additional focus to the approach
Focus on the human aspects (psychosocial
component).
Involvement of sexual partners in treatment.
Community aspect
Condom promotion
Additional focus to the approach
Focus on the human aspects (psychosocial
component).
Involvement of sexual partners in treatment.
Community aspect
Condom promotion
6
Significance of STIs in Malawi
Malawi has high rates of sexually transmitted
infections.
HIV prevalence is estimated at 14.2% at
national level.
Concern on syphilis prevalence, 3.9% (NAC
2001).
High STI incidence and high HIV prevalence
drain limited resources.
Significance of STIs in Malawi
Malawi has high rates of sexually transmitted
infections.
HIV prevalence is estimated at 14.2% at
national level.
Concern on syphilis prevalence, 3.9% (NAC
2001).
High STI incidence and high HIV prevalence
drain limited resources.
7
Significance………………………
STI is the fourth common reason for out
patient visit.
Asymptomatic nature of some STI remains a
challenge ( 80% of STIs are asymptomatic
esp. in women)
Significance………………………
STI is the fourth common reason for out
patient visit.
Asymptomatic nature of some STI remains a
challenge ( 80% of STIs are asymptomatic
esp. in women)
8
consequences
Blinding eye infections
Infertility
Spontaneous abortions
Ectopic pregnances
Cervical cancer
Death
Chronic abdominal pains- infertility in women
Infertility in men- gonorrhea & chlamydia
consequences
Blinding eye infections
Infertility
Spontaneous abortions
Ectopic pregnances
Cervical cancer
Death
Chronic abdominal pains- infertility in women
Infertility in men- gonorrhea & chlamydia
9
Consequences………………..
Increased risk of HIV infection
Irreversible damage to the brain and heart
Extensive organ and tissue destruction in
newborns.
Social disruption
Consequences………………..
Increased risk of HIV infection
Irreversible damage to the brain and heart
Extensive organ and tissue destruction in
newborns.
Social disruption
10
Major modes of transmission
Unprotected sexual intercourse with an
infected partner (Main mode – >80%)
Mother to child transmission (in utero or
during birth.
Breast feeding – esp HIV .
Major modes of transmission
Unprotected sexual intercourse with an
infected partner (Main mode – >80%)
Mother to child transmission (in utero or
during birth.
Breast feeding – esp HIV .
11
Link between STIs and HIV
Measures of prevention are the same
Modes of transmission are the same
HIV affects the treatment response to STIs
STI increases risk of getting HIV (5-10 times)
HIV infection may complicate STI diagnosis
STI symptoms may be more severe in HIV +ve patients.
Treating STI effectively reduces transmission of HIV
significantly.
Link between STIs and HIV
Measures of prevention are the same
Modes of transmission are the same
HIV affects the treatment response to STIs
STI increases risk of getting HIV (5-10 times)
HIV infection may complicate STI diagnosis
STI symptoms may be more severe in HIV +ve patients.
Treating STI effectively reduces transmission of HIV
significantly.
12
HISTORY TAKING
AND EXAMINATION
HISTORY TAKING
AND EXAMINATION
13
TWO IMPORTANT REASONS FOR OBTAINING A
THOUROUGH HISTORY.
It helps the service provider learn about the
client’s symptoms- increase in diagnostic
reliability.
It provides valuable information for
prevention, counselling and partner
notification and treatment.
TWO IMPORTANT REASONS FOR OBTAINING A
THOUROUGH HISTORY.
It helps the service provider learn about the
client’s symptoms- increase in diagnostic
reliability.
It provides valuable information for
prevention, counselling and partner
notification and treatment.
14
IMPORTANCE OF THE SERVICE PROVIDER
GAINING CLIENT’S TRUST.
The client may feel uncomfortable talking
about sex.
The client may withhold information to protect
sexual partners
The client may feel intimidated by service a
provider of a different social status or speaks
of a different language.
IMPORTANCE OF THE SERVICE PROVIDER
GAINING CLIENT’S TRUST.
The client may feel uncomfortable talking
about sex.
The client may withhold information to protect
sexual partners
The client may feel intimidated by service a
provider of a different social status or speaks
of a different language.
15
WAYS A SERVICE PROVIDER CAN HELP A CLIENT FEEL
MORE AT EASE
Greet the client in a friendly manner
Make sure that your body gives the same friendly, relaxed
message as your words.
Speak whichever the language the client indicates is most
comfortable for talking about sexual issues
Ask the client’s permission to bring up personal questions.
Avoid dwelling on sensitive issues
Phrase your questions politely
Ask one question at a time
Use non medical terms
WAYS A SERVICE PROVIDER CAN HELP A CLIENT FEEL
MORE AT EASE
Greet the client in a friendly manner
Make sure that your body gives the same friendly, relaxed
message as your words.
Speak whichever the language the client indicates is most
comfortable for talking about sexual issues
Ask the client’s permission to bring up personal questions.
Avoid dwelling on sensitive issues
Phrase your questions politely
Ask one question at a time
Use non medical terms
16
Cont`d
Avoid leading questions
Keep your questions free from moral
judgement
Make questions specific and clear
Cont`d
Avoid leading questions
Keep your questions free from moral
judgement
Make questions specific and clear
17
COMPONENTS OF THE ‘GATHER’ PROCESS USED IN
OBTAINING THE HISTORY AND THE TYPES OF
INFORMATION TO BE OBTAINED.
First three steps of the ‘GATHER’ process
GREET, ASK and TELL
General details
Symptoms of present illness
Specific questions for female clients
Medical history, especially previous history of STIs
and or STI treatment.
Sexual History.
COMPONENTS OF THE ‘GATHER’ PROCESS USED IN
OBTAINING THE HISTORY AND THE TYPES OF
INFORMATION TO BE OBTAINED.
First three steps of the ‘GATHER’ process
GREET, ASK and TELL
General details
Symptoms of present illness
Specific questions for female clients
Medical history, especially previous history of STIs
and or STI treatment.
Sexual History.
18
IMPORTANCE OF PERFORMING A PHYSICAL
EXAMINATION ON A CLIENT
It enables the provider to confirm the
symptoms the client has described.
It allows the provider to confirm or rule out
various syndromes.
IMPORTANCE OF PERFORMING A PHYSICAL
EXAMINATION ON A CLIENT
It enables the provider to confirm the
symptoms the client has described.
It allows the provider to confirm or rule out
various syndromes.
19
POINTS TO CONSIDER BEFORE PERFORMING A
PHYSICAL EXAMINATION
Explain to the client what is going to be
done
Ask for his/her verbal consent
Provide privacy
Wear gloves only when examining genital
area.
POINTS TO CONSIDER BEFORE PERFORMING A
PHYSICAL EXAMINATION
Explain to the client what is going to be
done
Ask for his/her verbal consent
Provide privacy
Wear gloves only when examining genital
area.
20
Role Play Script
Service Provider’s Role
You are a service provider working at an STI clinic. Today Mrs. Ngozo reports to
your clinic with a STI problem. However, her husband has no problem.
Your job is to obtain a complete history and perform a thorough physical
examination.
Client’s Role
You are Mrs. Ngozo, aged 30 years. You work at Tidziwane Rest House as a
housekeeper. You live with your husband in the nearby village. Your husband is 40
years old, a business man who sells fish in the urban areas and travels quite often.
You consider your relationship with your husband to be good. However, you have
not discussed the present problem with him.
Today you have come to the STI clinic complaining of pain when passing urine,
excessive vaginal discharge, lower abdominal pain and pain during intercourse.
You are concerned that your husband may have been unfaithful while travelling for
his work. You decide to talk to the Service Provider about this concern.
Role Play Script
Service Provider’s Role
You are a service provider working at an STI clinic. Today Mrs. Ngozo reports to
your clinic with a STI problem. However, her husband has no problem.
Your job is to obtain a complete history and perform a thorough physical
examination.
Client’s Role
You are Mrs. Ngozo, aged 30 years. You work at Tidziwane Rest House as a
housekeeper. You live with your husband in the nearby village. Your husband is 40
years old, a business man who sells fish in the urban areas and travels quite often.
You consider your relationship with your husband to be good. However, you have
not discussed the present problem with him.
Today you have come to the STI clinic complaining of pain when passing urine,
excessive vaginal discharge, lower abdominal pain and pain during intercourse.
You are concerned that your husband may have been unfaithful while travelling for
his work. You decide to talk to the Service Provider about this concern.
21
SYNDROMIC MANAGEMENT OF STIs
Based on the identification of consistent and
similar groups of symptoms and signs
(syndromes), and the provision of treatment
that will deal with the majority of organisms
responsible for producing each syndrome.
SYNDROMIC MANAGEMENT OF STIs
Based on the identification of consistent and
similar groups of symptoms and signs
(syndromes), and the provision of treatment
that will deal with the majority of organisms
responsible for producing each syndrome.
22
Cont`d
Traditional diagnosis of STIs has relied on
identifying the organism causing the
symptoms through sophisticated laboratory
diagnosis.
This is very expensive and impractical in
most developing countries.
Cont`d
Traditional diagnosis of STIs has relied on
identifying the organism causing the
symptoms through sophisticated laboratory
diagnosis.
This is very expensive and impractical in
most developing countries.
23
Cont`d
Even when laboratory facilities are available,
it may take several days to conduct the lab
tests and get the results back.
If the client does not get treatment until the
test results are back, he/she may have
continued to spread the disease during this
period.
Cont`d
Even when laboratory facilities are available,
it may take several days to conduct the lab
tests and get the results back.
If the client does not get treatment until the
test results are back, he/she may have
continued to spread the disease during this
period.
24
Cont`d
A consistent and commonly occurring group
of signs and symptoms is known as
SYNDROME.
For example: Urethral discharge might be
caused by C. trachomatis or N. gonorrhoea.
Thus, the symptom of urethral discharge
would be the basis for identifying the
syndrome.
Cont`d
A consistent and commonly occurring group
of signs and symptoms is known as
SYNDROME.
For example: Urethral discharge might be
caused by C. trachomatis or N. gonorrhoea.
Thus, the symptom of urethral discharge
would be the basis for identifying the
syndrome.
25
Cont`d
The client would then be treated for the most
common infections that might have caused
that particular set of symptoms and signs.
In case of urethral discharge, the treatment
would target both C. trachomatis and N.
gonorrhoea
Cont`d
The client would then be treated for the most
common infections that might have caused
that particular set of symptoms and signs.
In case of urethral discharge, the treatment
would target both C. trachomatis and N.
gonorrhoea
26
ADVANTAGES
Rapid and effective treatment with no need
for laboratory support
Can begin treatment immediately, thereby
decreasing spread of STIs.
Treatment is available at primary care level.
Multiple drug treatment ensures broad
coverage of pathogens
ADVANTAGES
Rapid and effective treatment with no need
for laboratory support
Can begin treatment immediately, thereby
decreasing spread of STIs.
Treatment is available at primary care level.
Multiple drug treatment ensures broad
coverage of pathogens
27
DISADVANTAGES
Requires training of clinicians in syndromic case
management
Lack of specificity in diagnosis means that several
drugs may be used despite the presence of only one
pathogen.
There must be continued epidemiological surveillance
of the organisms that cause the syndromes and their
resistance to drugs.
DISADVANTAGES
Requires training of clinicians in syndromic case
management
Lack of specificity in diagnosis means that several
drugs may be used despite the presence of only one
pathogen.
There must be continued epidemiological surveillance
of the organisms that cause the syndromes and their
resistance to drugs.
28
Why Involving sexual partners in
treatment
Why Involving sexual partners in
treatment
29
Reasons for treating contacts
To ensure the partner receives treatment for
possible STIs
To prevent the spread of infection by the
untreated partner.
To ensure the client is not infected after
treatment.
Reasons for treating contacts
To ensure the partner receives treatment for
possible STIs
To prevent the spread of infection by the
untreated partner.
To ensure the client is not infected after
treatment.
30
Beliefs and expectations regarding
telling his or her partner.
Worry about sexual partner being angry and
blaming him/her for unfaithfulness.
Disappointment, anger, suspicion about
sexual partners.
Embarrassment shame and worry.
Beliefs and expectations regarding
telling his or her partner.
Worry about sexual partner being angry and
blaming him/her for unfaithfulness.
Disappointment, anger, suspicion about
sexual partners.
Embarrassment shame and worry.
31
Cont……………………………….
Concern about how to talk to and bring
sexual partners for treatment.
Concerns about whether they will be cured.
Concerns about whether the illness is due to
HIV.
Cont……………………………….
Concern about how to talk to and bring
sexual partners for treatment.
Concerns about whether they will be cured.
Concerns about whether the illness is due to
HIV.
32
6 points the client should consider
telling partners
How the client was exposed and the risk of
infection.
Where to get treatment.
Why sexual activity should be avoided until
disease is cured.
6 points the client should consider
telling partners
How the client was exposed and the risk of
infection.
Where to get treatment.
Why sexual activity should be avoided until
disease is cured.
33
Cont……………………………
That the partner may be infected even if she
shows no symptoms.
STIs can cause life threatening complications
The infected person can infect others as long
as he or she is untreated.
Cont……………………………
That the partner may be infected even if she
shows no symptoms.
STIs can cause life threatening complications
The infected person can infect others as long
as he or she is untreated.
34
Topics
Gonorrhea/Chlamydia
Syphilis
Bubo
Herpes
Genital Warts
Topics
Gonorrhea/Chlamydia
Syphilis
Bubo
Herpes
Genital Warts
35
Gonorrhea
Gonorrhea
36
Gonorrhea
Gonorrhea is commonly known as Chindoko
Incubation period: 1 – 14 days
A bacteria causing gonorrhea is Neisseria
gonorrhoea.
Can cause infections in men, women, and new
babies
The person can easily pass it on to sex partners
and babies during childbirth.
Gonorrhea
Gonorrhea
Gonorrhea is commonly known as Chindoko
Incubation period: 1 – 14 days
A bacteria causing gonorrhea is Neisseria
gonorrhoea.
Can cause infections in men, women, and new
babies
The person can easily pass it on to sex partners
and babies during childbirth.
Gonorrhea
37
Gonorrhea Symptoms in Men
Discharge from the
penis (may be thick,
milky white, yellowish,
or greenish)
Burning on urination
Source: CDC/NCHSTP/Division of STD Prevention, STD
Clinical Slides
Gonorrhea
Gonorrhea Symptoms in Men
Discharge from the
penis (may be thick,
milky white, yellowish,
or greenish)
Burning on urination
Source: CDC/NCHSTP/Division of STD Prevention, STD
Clinical Slides
Gonorrhea
38
39
40
Complications in Men
Swollen or tender testicles (epididymitis)
Disseminated gonococcal infection (DGI)
Infertility
Gonorrhea
Complications in Men
Swollen or tender testicles (epididymitis)
Disseminated gonococcal infection (DGI)
Infertility
Gonorrhea
41
Swollen or Tender Testicles
(Epididymitis)
Gonorrhea
Swollen or Tender Testicles
(Epididymitis)
Gonorrhea
42
Disseminated Gonococcal
(Gonorrhea) Infection
Gonorrhea
Disseminated Gonococcal
(Gonorrhea) Infection
Gonorrhea
43
Gonorrhea Symptoms in Women
Usually
asymptomatic
Painful urination
Abnormal vaginal
bleeding
Pain during sex
Source: CDC/NCHSTP/Division of STD Prevention, STD
Clinical Slides
Gonorrhea
Gonorrhea Symptoms in Women
Usually
asymptomatic
Painful urination
Abnormal vaginal
bleeding
Pain during sex
Source: CDC/NCHSTP/Division of STD Prevention, STD
Clinical Slides
Gonorrhea
44
Vaginal discharge
Vaginal discharge
45
Discharge in women from
gonorrhoea/Chlamydia/candida
Discharge in women from
gonorrhoea/Chlamydia/candida
46
Complications in Women
Bartholin’s Abscess
Pelvic inflammatory disease (PID)
Disseminated gonococcal infection (DGI)
Infertility
Gonorrhea
Complications in Women
Bartholin’s Abscess
Pelvic inflammatory disease (PID)
Disseminated gonococcal infection (DGI)
Infertility
Gonorrhea
47
Bartholin’s Abscess
Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides
Gonorrhea
Bartholin’s Abscess
Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides
Gonorrhea
48
Pelvic Inflammatory Disease (PID)
Source: Cincinnati STD/HIV Prevention Training Center
Gonorrhea
Pelvic Inflammatory Disease (PID)
Source: Cincinnati STD/HIV Prevention Training Center
Gonorrhea
49
ANATOMY - DRAWING
PID
Definition:- Infection of female genital tract
above the internal os of the cervix.
This results from infection ascending from
the cervix.
CAUSES:
(i) Neisseria gonorrhoea
(ii) Chlamydia trachomatis
ANATOMY - DRAWING
PID
Definition:- Infection of female genital tract
above the internal os of the cervix.
This results from infection ascending from
the cervix.
CAUSES:
(i) Neisseria gonorrhoea
(ii) Chlamydia trachomatis
50
51
CONT…
ANAEROBES
Usually of the Bacteriodes
species)
Rare cause:-
- Mycoplasma homines
SIGNS:-
After examination
- Temperature (Low)
- Abdominal
palpation
SIGNS AND
SYMPTOMS
- Abnominal pain
- Painful intercourse
- Vaginal discharge
- Dysuria
- Fever
- Pains associated
with menses.
- Nausea and
vomiting
CONT…
ANAEROBES
Usually of the Bacteriodes
species)
Rare cause:-
- Mycoplasma homines
SIGNS:-
After examination
- Temperature (Low)
- Abdominal
palpation
SIGNS AND
SYMPTOMS
- Abnominal pain
- Painful intercourse
- Vaginal discharge
- Dysuria
- Fever
- Pains associated
with menses.
- Nausea and
vomiting
52
Gonorrhea in Infants
A mother can pass
gonorrhea to her
baby during
childbirth
Gonorrhea
Gonorrhea in Infants
A mother can pass
gonorrhea to her
baby during
childbirth
Gonorrhea
53
Neonatal Gonorrhoea
Neonatal Gonorrhoea
54
55
Treatment for Gonorrhea
Easily cured with antibiotics; but
REMEMBER:
Any damage to the body cannot be
repaired.
Gonorrhea
Treatment for Gonorrhea
Easily cured with antibiotics; but
REMEMBER:
Any damage to the body cannot be
repaired.
Gonorrhea
56
Cont`d
If microscopy is available, urine/urethral smear may
show an increased number of polymorphonuclear
leukocytes and a Gram stain may demonstrate the
presence of gonococci.
In males, more than 5 polymorphonuclear
leukocytes per HPF (x 1000) are indicative of
Urethritis.
Cont`d
If microscopy is available, urine/urethral smear may
show an increased number of polymorphonuclear
leukocytes and a Gram stain may demonstrate the
presence of gonococci.
In males, more than 5 polymorphonuclear
leukocytes per HPF (x 1000) are indicative of
Urethritis.
57
Chlamydia
Chlamydia
58
Chlamydia
Can cause infection in men (urethral
discharge), women (vaginal discharge), and
newborn babies
Chlamydia is caused by a bacteria
Incubation Period: 2-3 weeks
The person can pass it on to sex partners
and to babies during childbirth
Chlamydia
Chlamydia
Can cause infection in men (urethral
discharge), women (vaginal discharge), and
newborn babies
Chlamydia is caused by a bacteria
Incubation Period: 2-3 weeks
The person can pass it on to sex partners
and to babies during childbirth
Chlamydia
59
Symptoms of Chlamydia
Symptoms in Women:
Usually asymptomatic
Abnormal vaginal
discharge
Pain during sex
Complications, if not
treated:
Pelvic inflammatory
disease (PID)
Symptoms in Men:
Usually asymptomatic
Discharge from the penis
(may be runny, whitish)
Burning on urination
Complications, if not
treated
Swollen and tender
testicles (epididymitis)
Chlamydia
Symptoms of Chlamydia
Symptoms in Women:
Usually asymptomatic
Abnormal vaginal
discharge
Pain during sex
Complications, if not
treated:
Pelvic inflammatory
disease (PID)
Symptoms in Men:
Usually asymptomatic
Discharge from the penis
(may be runny, whitish)
Burning on urination
Complications, if not
treated
Swollen and tender
testicles (epididymitis)
Chlamydia
60
Chlamydia Symptoms in Men
Chlamydia
Source: Seattle STD/HIV PTC
Chlamydia Symptoms in Men
Chlamydia
Source: Seattle STD/HIV PTC
61
Chlamydia Symptoms in Women
Mucopurulent Cervicitis
Chlamydia
Source: St. Louis STD/HIV PTC
Chlamydia Symptoms in Women
Mucopurulent Cervicitis
Chlamydia
Source: St. Louis STD/HIV PTC
62
Treatment for Chlamydia
Easily cured with
antibiotics; but
REMEMBER:
Any damage to the
body cannot be
repaired
Chlamydia
Treatment for Chlamydia
Easily cured with
antibiotics; but
REMEMBER:
Any damage to the
body cannot be
repaired
Chlamydia
63
Syndromic Management
Syndromic management for the above
conditions will include all the causative
organisms under the flowcharts of Urethral
Discharge, Abnormal vaginal Discharge and
Lower Abdominal Pains (PID) in women as
shown below.
Syndromic Management
Syndromic management for the above
conditions will include all the causative
organisms under the flowcharts of Urethral
Discharge, Abnormal vaginal Discharge and
Lower Abdominal Pains (PID) in women as
shown below.
64
65
66
AVD
cervicitis
vaginitis
AVD
cervicitis
vaginitis
67
68
Pelvic Inflammatory Disease (PID)
with LAP
Source: Cincinnati STD/HIV Prevention Training Center
Gonorrhea
Pelvic Inflammatory Disease (PID)
with LAP
Source: Cincinnati STD/HIV Prevention Training Center
Gonorrhea
69
70
Prevention
Be faithful to one sexual partner
Correct & consistence use of condoms
Treating all sexual partners
Prevention
Be faithful to one sexual partner
Correct & consistence use of condoms
Treating all sexual partners
71
Syphilis
Syphilis
72
Syphilis
Syphilis is commonly called Chidzonono
Syphilis is caused by a bacteria – Treponema
pallidum
Incubation Period: 10-90 days (average 21
days)
Can cause infections in men, women, and
unborn babies during pregnancy.
Syphilis
Syphilis
Syphilis is commonly called Chidzonono
Syphilis is caused by a bacteria – Treponema
pallidum
Incubation Period: 10-90 days (average 21
days)
Can cause infections in men, women, and
unborn babies during pregnancy.
Syphilis
73
Symptoms of Syphilis
Primary Stage
A painless sore called a chancre may be located on
the genitals, lips, anus, or other area of direct
contact
The chancre will last 1-5 weeks and heal without
treatment
The person can easily pass it on to sex partners
Syphilis
Symptoms of Syphilis
Primary Stage
A painless sore called a chancre may be located on
the genitals, lips, anus, or other area of direct
contact
The chancre will last 1-5 weeks and heal without
treatment
The person can easily pass it on to sex partners
Syphilis
74
Primary Syphilis Chancre in a Man
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Syphilis
Primary Syphilis Chancre in a Man
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Syphilis
75
Cont`d
Cont`d
76
Cont`d
Cont`d
77
Primary Syphilis Chancre in a
Woman
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Syphilis
Primary Syphilis Chancre in a
Woman
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Syphilis
78
Cont`d
Cont`d
79
Syphilic Ulcers
Primary chancres
Syphilic Ulcers
Primary chancres
80
81
Oral Primary Syphilis Chancre
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Syphilis
Oral Primary Syphilis Chancre
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Syphilis
82
Symptoms of Syphilis
Secondary Stage
Skin rashes lasting 2 – 6 weeks (average of 4 weeks) on
the palms of the hands, bottoms of the feet, or any part of
the body
Other symptoms include fever, swollen lymph glands,
headache, hair loss, and muscle ache
Symptoms will go away without treatment
The person may be able to pass it on to sex partners.
Syphilis
Symptoms of Syphilis
Secondary Stage
Skin rashes lasting 2 – 6 weeks (average of 4 weeks) on
the palms of the hands, bottoms of the feet, or any part of
the body
Other symptoms include fever, swollen lymph glands,
headache, hair loss, and muscle ache
Symptoms will go away without treatment
The person may be able to pass it on to sex partners.
Syphilis
83
Secondary Syphilis Body Rash
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Syphilis
Secondary Syphilis Body Rash
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Syphilis
84
Secondary Syphilis
Secondary syphilis is one of the few infectious diseases that produces rashes on the palms and soles,
as well as a generalized rash. If an ulcer on the penis is followed several weeks later by a rash, the person
should always be evaluated for syphilis.
Secondary Syphilis
Secondary syphilis is one of the few infectious diseases that produces rashes on the palms and soles,
as well as a generalized rash. If an ulcer on the penis is followed several weeks later by a rash, the person
should always be evaluated for syphilis.
85
Secondary Syphilis Rash
Source: Cincinnati STD/HIV Prevention Training Center
Syphilis
Secondary Syphilis Rash
Source: Cincinnati STD/HIV Prevention Training Center
Syphilis
86
Secondary Syphilis Palm Rash
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Syphilis
Secondary Syphilis Palm Rash
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Syphilis
87
Symptoms of Syphilis
Late Stage
Paralysis
Insanity
Blindness
Damage to knee joints
Personality changes
Impotency
Aneurysm (ballooning
of a blood vessel)
Tumor on the skin or
internal organs
Syphilis
Symptoms of Syphilis
Late Stage
Paralysis
Insanity
Blindness
Damage to knee joints
Personality changes
Impotency
Aneurysm (ballooning
of a blood vessel)
Tumor on the skin or
internal organs
Syphilis
88
Late Stage Syphilis
Ulcerating Gumma
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Syphilis
Late Stage Syphilis
Ulcerating Gumma
Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides
Syphilis
89
Congenital Syphilis
A mother can pass
syphilis on to her
unborn child
Syphilis
Congenital Syphilis
A mother can pass
syphilis on to her
unborn child
Syphilis
90
Congenital Syphilis
Congenital Syphilis
91
92
Cont`d
Cont`d
93
Congenital syphilis
Condyloma lata
Saddle nose
← Hutchinson teeth
bone changes (Saber shins)→
Scarring of the skin around earlier lesions on the mouth,
genitalia, and anus (called rhagades)
Later rash -- copper-coloured, flat or bumpy
(maculopapular) rash on the face, palms, soles
Early rash -- small blisters (vesicles)
on the palms and soles
Congenital syphilis
Condyloma lata
Saddle nose
← Hutchinson teeth
bone changes (Saber shins)→
Scarring of the skin around earlier lesions on the mouth,
genitalia, and anus (called rhagades)
Later rash -- copper-coloured, flat or bumpy
(maculopapular) rash on the face, palms, soles
Early rash -- small blisters (vesicles)
on the palms and soles
94
Nasty complications of Syphilis
Nasty complications of Syphilis
95
Cont`d
Cont`d
96
Cont`d
Cont`d
97
98
Testing & Treatment for Syphilis
Easily detected by a blood
test; and
Easily cured with
antibiotics;
Any damage done to the
body cannot be repaired.
Syphilis
Testing & Treatment for Syphilis
Easily detected by a blood
test; and
Easily cured with
antibiotics;
Any damage done to the
body cannot be repaired.
Syphilis
99
Methods of Prevention Advocated
Be faithful to one sexual partner
Correct & consistence use of condoms
Routine Antenatal Screening of syphilis
Routine blood screening for syphilis
Treating all sexual partners
Methods of Prevention Advocated
Be faithful to one sexual partner
Correct & consistence use of condoms
Routine Antenatal Screening of syphilis
Routine blood screening for syphilis
Treating all sexual partners
100
Lymphogranuloma Venerium
[BUBO]
Chancroid and
Lymphogranuloma
venereum (LGV)
cause buboes.
When a bubo is
caused by
chancroid, a genital
ulcer could also be
present, but
occasionally may
not be.
Lymphogranuloma Venerium
[BUBO]
Chancroid and
Lymphogranuloma
venereum (LGV)
cause buboes.
When a bubo is
caused by
chancroid, a genital
ulcer could also be
present, but
occasionally may
not be.
101
If the bubo is caused by LGV, a genital ulcer may not be
present. Buboes may be unilateral or bilateral, thus the groin
must be examined on both sides.
Lymph nodes in the inguinal region may enlarge for a variety
of reasons, which include:-
Septic skin lesions on thighs, leg, foot, toes, buttocks,
anus, perineum, scrotum, penis, labia, vulva and vagina.
Systemic infections such as hepatitis B, HIV infection,
TB, syphilis, infectious mononucleosis.
Other infections such as bubonic plague, cat scratch
fever, trypanosomiasis.
If the bubo is caused by LGV, a genital ulcer may not be
present. Buboes may be unilateral or bilateral, thus the groin
must be examined on both sides.
Lymph nodes in the inguinal region may enlarge for a variety
of reasons, which include:-
Septic skin lesions on thighs, leg, foot, toes, buttocks,
anus, perineum, scrotum, penis, labia, vulva and vagina.
Systemic infections such as hepatitis B, HIV infection,
TB, syphilis, infectious mononucleosis.
Other infections such as bubonic plague, cat scratch
fever, trypanosomiasis.
102
BUBO
BUBO
103
104
Scrotal Swelling
SS
Scrotal Swelling
SS
105
Cont`d
Inflammation of the epididymis (epididymitis) usually
manifests itself by acute onset of unilateral testicular
pain and swelling, often tenderness of the epididymis
and vas deferens, and occasionally with erythema and
oedema of the overlying skin.
In men under 35 years this is more frequently caused
by sexually transmitted organisms than in men over 35
years.
When the epididymitis is accompanied by urethral
discharge, it should be presumed to be sexually
transmitted origin, commonly gonococcal and or
chlamydial in nature.
Cont`d
Inflammation of the epididymis (epididymitis) usually
manifests itself by acute onset of unilateral testicular
pain and swelling, often tenderness of the epididymis
and vas deferens, and occasionally with erythema and
oedema of the overlying skin.
In men under 35 years this is more frequently caused
by sexually transmitted organisms than in men over 35
years.
When the epididymitis is accompanied by urethral
discharge, it should be presumed to be sexually
transmitted origin, commonly gonococcal and or
chlamydial in nature.
106
CAUSES
Gonorrhoea
Chlamydia Trachomatis
Bacterium E. Coli
Mumps virus
TB
Klebsiella
Pseudomonas aeruginosa
Coliform in children
CAUSES
Gonorrhoea
Chlamydia Trachomatis
Bacterium E. Coli
Mumps virus
TB
Klebsiella
Pseudomonas aeruginosa
Coliform in children
107
Cont`d
Scrotal swelling is commonly encountered in
clinical practice.
Symptoms may be due to long standing
problems like hydrocele, varicocele or inguinal
hernia.
Other symptoms may be due to acute illnesses
like torsion of testis, strangulated hernia and
trauma.
Cont`d
Scrotal swelling is commonly encountered in
clinical practice.
Symptoms may be due to long standing
problems like hydrocele, varicocele or inguinal
hernia.
Other symptoms may be due to acute illnesses
like torsion of testis, strangulated hernia and
trauma.
108
TORSION OF THE TESTIS
The testis twists around itself causing a twist in
the spermatic cord, blocks the blood supply.
There may be total obstruction of blood supply
to the testis.
This condition is serious and can lead to gas
gangrene and death.
TORSION OF THE TESTIS
The testis twists around itself causing a twist in
the spermatic cord, blocks the blood supply.
There may be total obstruction of blood supply
to the testis.
This condition is serious and can lead to gas
gangrene and death.
109
CLINICAL FEATURES
Sudden pain and scrotal swelling in one or two
sacs
Abdominal pain
Vomiting
Hot, swollen and tender scrotum
Elevation/rotation of the testis
NB: Rule out Surgical Causes of SS &
treat appropriately
CLINICAL FEATURES
Sudden pain and scrotal swelling in one or two
sacs
Abdominal pain
Vomiting
Hot, swollen and tender scrotum
Elevation/rotation of the testis
NB: Rule out Surgical Causes of SS &
treat appropriately
110
SS
SS
111
Swollen or Tender Testicles
(Epididymitis)
Gonorrhea
Swollen or Tender Testicles
(Epididymitis)
Gonorrhea
112
113
Balanitis
BA
Balanitis
BA
114
DEFINITION
Balanoposthitis - inflammation of glans penis
and the foreskin in an uncircumcised male
Inflammation of glans penis in a circumcised
male
Candida Albicans
CAUSES
Poor personal hygiene
Trichomonas
Drug reaction
DEFINITION
Balanoposthitis - inflammation of glans penis
and the foreskin in an uncircumcised male
Inflammation of glans penis in a circumcised
male
Candida Albicans
CAUSES
Poor personal hygiene
Trichomonas
Drug reaction
115
Signs
Itchiness of the glans penis
Follicular rash
Redness
Discharge
Excoriation of the foreskin
Signs
Itchiness of the glans penis
Follicular rash
Redness
Discharge
Excoriation of the foreskin
116
Balanitis
Balanitis
117
118
Herpes Simplex Virus (HSV)
Herpes Simplex Virus (HSV)
119
Genital Herpes
Causes infection in men, women, and
newborns
Herpes simplex viruses (HSV) cause genital
herpes infections.
Incubation period: 2 – 12 days
The person can easily pass it on to sex
partners and babies during childbirth
Herpes
Genital Herpes
Causes infection in men, women, and
newborns
Herpes simplex viruses (HSV) cause genital
herpes infections.
Incubation period: 2 – 12 days
The person can easily pass it on to sex
partners and babies during childbirth
Herpes
120
Genital Herpes: Two Types
There are 2 types of HSV: HSV-1 and
HSV-2.
–HSV-2 causes most genital infections.
–HSV-1 causes oral infections (cold sores,
fever blisters) and some genital infections.
Herpes
Genital Herpes: Two Types
There are 2 types of HSV: HSV-1 and
HSV-2.
–HSV-2 causes most genital infections.
–HSV-1 causes oral infections (cold sores,
fever blisters) and some genital infections.
Herpes
121
Symptoms of Genital Herpes
Numerous painful lesions (sores)
On the penis, vagina, anus, buttocks, thighs,
mouth, or finger
Last up to 4 – 21 days
Other symptoms include headache, fever,
muscle aches, swollen lymph nodes, and
difficult urination.
Symptoms may or may not come back.
Herpes
Symptoms of Genital Herpes
Numerous painful lesions (sores)
On the penis, vagina, anus, buttocks, thighs,
mouth, or finger
Last up to 4 – 21 days
Other symptoms include headache, fever,
muscle aches, swollen lymph nodes, and
difficult urination.
Symptoms may or may not come back.
Herpes
122
Genital Herpes Without Symptoms
Many people with herpes do not have any
symptoms or do not recognize that they have
symptoms.
Most people with herpes can pass the virus
to sex partners even when they do not have
symptoms.
Herpes
Genital Herpes Without Symptoms
Many people with herpes do not have any
symptoms or do not recognize that they have
symptoms.
Most people with herpes can pass the virus
to sex partners even when they do not have
symptoms.
Herpes
123
Herpes in a Man
Source: Cincinnati STD/HIV Prevention Training Center
Herpes
Herpes in a Man
Source: Cincinnati STD/HIV Prevention Training Center
Herpes
124
Herpes Simplex Virus (vesicles)
Herpes Simplex Virus (vesicles)
125
Herpes in a Woman
Source: Cincinnati STD/HIV Prevention Training
Center
Herpes
Source: CDC/NCHSTP/Division of STD,
STD Clinical Slides
Herpes in a Woman
Source: Cincinnati STD/HIV Prevention Training
Center
Herpes
Source: CDC/NCHSTP/Division of STD,
STD Clinical Slides
126
You can get herpes anywhere . . .
Source: Cincinnati STD/HIV Prevention Training Center
Herpes
You can get herpes anywhere . . .
Source: Cincinnati STD/HIV Prevention Training Center
Herpes
127
Herpes Complications
HSV-2 causes serious
problems when it is
passed to newborns
during birth.
Herpes
Herpes Complications
HSV-2 causes serious
problems when it is
passed to newborns
during birth.
Herpes
128
Testing & Treatment for
Genital Herpes
Can be detected by:
culturing the lesion
blood test
Herpes cannot be cured, but
symptoms can be treated with
medicines called antivirals
(Acyclovir).
You can still spread
herpes even if you are
taking antiviral
medicine!
Herpes
Testing & Treatment for
Genital Herpes
Can be detected by:
culturing the lesion
blood test
Herpes cannot be cured, but
symptoms can be treated with
medicines called antivirals
(Acyclovir).
You can still spread
herpes even if you are
taking antiviral
medicine!
Herpes
129
Human Papillomavirus (HPV)
Causes Genital Warts
Human Papillomavirus (HPV)
Causes Genital Warts
130
Human Papillomavirus
Many types of Human Papillomavirus (HPV),
some of which infect the genital area
Incubation period unclear
Can infect men, women, and newborns
The person can easily pass it on to sex
partners
HPV
Human Papillomavirus
Many types of Human Papillomavirus (HPV),
some of which infect the genital area
Incubation period unclear
Can infect men, women, and newborns
The person can easily pass it on to sex
partners
HPV
131
HPV Penile Warts
Source: Cincinnati STD/HIV Prevention Training Center
HPV
HPV Penile Warts
Source: Cincinnati STD/HIV Prevention Training Center
HPV
132
Genital Warts in a Woman
HPV
Source: CDC/NCHSTP/Division of STD, STD Clinical Slides
Genital Warts in a Woman
HPV
Source: CDC/NCHSTP/Division of STD, STD Clinical Slides
133
Perianal Wart
Source: Cincinnati STD/HIV Prevention Training Center
HPV
Perianal Wart
Source: Cincinnati STD/HIV Prevention Training Center
HPV
134
Genital HPV: Two Types
The types of HPV that infect the genital area
are labeled “low-risk” or “high-risk”
depending on whether they can cause cancer
or not.
Low-risk HPV types can cause genital warts.
High-risk HPV types can cause serious
cervical lesions, cervical cancer, and other
genital cancers.
HPV
Genital HPV: Two Types
The types of HPV that infect the genital area
are labeled “low-risk” or “high-risk”
depending on whether they can cause cancer
or not.
Low-risk HPV types can cause genital warts.
High-risk HPV types can cause serious
cervical lesions, cervical cancer, and other
genital cancers.
HPV
135
Symptoms of Genital HPV Infection
Usually asymptomatic and brief (6 – 12 months)
Genital warts (usually infection with low-risk type of
HPV)
Warts on the penis, vagina, anus or urethra
Rarely may have itching, bleeding, burning, or
pain along with the warts
May go away on their own, stay about the same,
or get worse
HPV
Symptoms of Genital HPV Infection
Usually asymptomatic and brief (6 – 12 months)
Genital warts (usually infection with low-risk type of
HPV)
Warts on the penis, vagina, anus or urethra
Rarely may have itching, bleeding, burning, or
pain along with the warts
May go away on their own, stay about the same,
or get worse
HPV
136
Symptoms of Genital HPV Infection
Cervical lesions (usually infection with high-risk type of
HPV)
Usually no symptoms
Detected by Pap smear
Most will go away on their own
Some will persist and need to be followed by health
care provider
Most women with high-risk HPV types do not get
cervical cancer
HPV
Symptoms of Genital HPV Infection
Cervical lesions (usually infection with high-risk type of
HPV)
Usually no symptoms
Detected by Pap smear
Most will go away on their own
Some will persist and need to be followed by health
care provider
Most women with high-risk HPV types do not get
cervical cancer
HPV
137
Testing & Treatment for
Genital Warts
Genital Warts
No tests for genital warts
Several types of treatment are available
Warts may come back
Cervical lesions and cervical cancer
VIA smears are best way to detect serious
lesions and prevent cervical cancer.
VIA is recommended for all sexually active
women.
HPV
Testing & Treatment for
Genital Warts
Genital Warts
No tests for genital warts
Several types of treatment are available
Warts may come back
Cervical lesions and cervical cancer
VIA smears are best way to detect serious
lesions and prevent cervical cancer.
VIA is recommended for all sexually active
women.
HPV
138
Cancer of the Cervix
Caused by HPV, sexually transmitted
10% of women with HPV will develop precancerous
cervical dysplasia, some will develop invasive cancer of
the cervix.
Post-coital bleeding should be investigated immediately.
Risk factors:
Early sexual activity (before 18)
Multiple sex partners
Exposure to other STIs
Immuno-suppression (due to HIV or steriod use)
Smoking
Cancer of the Cervix
Caused by HPV, sexually transmitted
10% of women with HPV will develop precancerous
cervical dysplasia, some will develop invasive cancer of
the cervix.
Post-coital bleeding should be investigated immediately.
Risk factors:
Early sexual activity (before 18)
Multiple sex partners
Exposure to other STIs
Immuno-suppression (due to HIV or steriod use)
Smoking
139
Diagnosis: Pap-smear or VIA
VIA is non-invasive, easy to perform and
inexpensive intervention with immediate results
which can be performed at HC level.
Local supplies: light, speculum, Acetic Acid
(vinegar), swabs and gloves.
VIA is currently available at selected sites
throughout the country
Diagnosis: Pap-smear or VIA
VIA is non-invasive, easy to perform and
inexpensive intervention with immediate results
which can be performed at HC level.
Local supplies: light, speculum, Acetic Acid
(vinegar), swabs and gloves.
VIA is currently available at selected sites
throughout the country
140
Cervical Cancer
Normal cervix with a smooth, glistening mucosal
surface. The cervical os is small and round,
typical for a nulliparous woman.
The os will have a fish-mouth shape after
pregnancy
Invasive Squamous Cell Cancer
Early invasive cancer:
Advanced invasive cervical cancer:
note the bulging, cauliflower-like,
ulceroproliferative growth with
bleeding and necrosis
Dense, chalky white complex acetowhite lesion
with raised and rolled out margin and irregular,
nodular surface suggestive of early invasive
cancer
Adenocarcinoma in situ :
The tips of some of the columnar villi
turn densely white compared to the
surrounding columnar villi after the
application of acetic acid (arrow).
The nabothian cysts turn white after
the application of acetic acid
Cervical Cancer
Normal cervix with a smooth, glistening mucosal
surface. The cervical os is small and round,
typical for a nulliparous woman.
The os will have a fish-mouth shape after
pregnancy
Invasive Squamous Cell Cancer
Early invasive cancer:
Advanced invasive cervical cancer:
note the bulging, cauliflower-like,
ulceroproliferative growth with
bleeding and necrosis
Dense, chalky white complex acetowhite lesion
with raised and rolled out margin and irregular,
nodular surface suggestive of early invasive
cancer
Adenocarcinoma in situ :
The tips of some of the columnar villi
turn densely white compared to the
surrounding columnar villi after the
application of acetic acid (arrow).
The nabothian cysts turn white after
the application of acetic acid
141
Prevention in General for STIs
Be faithful to one sexual partner
Correct & consistence use of condoms
Treating all sexual partners
Prevention in General for STIs
Be faithful to one sexual partner
Correct & consistence use of condoms
Treating all sexual partners
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